THIS  DISEASE  IS  BEYOND  MY  PRACTICE.” 


AN  ADDRESS 

BY 

Hon.  JOS.  B.  CUMMING 

AT  THE 

MEDICAL  COMMENCEMENT 

OF  THE 

UNIVERSITY  OF  GEORGIA 

MARCH  1,  1881. 


Chronicle  Job  Print, 
Augusta,  Ga. 


Digitized  by  the  Internet  Archive 
in  2016  with  funding  from 
Duke  University  Libraries 


https://archive.org/details/thisdiseaseisbeyOOcumm 


The  doctor  and  “the  waiting  gentle  woman"  watched  in 
the  ante-chamber  of  the  sick  Queen.  The  scene,  which  I 
speak  of,  is  laid  a long  time  ago.  The  saintly  Edward  the 
Confessor  sits  on  the  throne  of  England  and  Macbeth,  with 
desperate,  bloody  hand,  grasps  the  sceptre  of  Scotland.  The 
sick  chamber  is  bare  and  comfortless,  for  the  abodes  of  Kings 
in  those  times  and  those  then  rude  countries  of  Northern 
Europe  lacked  the  comforts  and  conveniences  of  domestic  life 
now  common  in  the  house  of  the  mechanic  and  the  cottage 
of  the  laborer;  and  this  Castle  of  Dunsinane,  destined  next 
day  to  witness  the  “equivocation  of  the  fiend  that  lies  like 
truth’’,  this  Dunsinane  where  “hang  out  the  banners  on  the 
outward  walls”,  this  Dunsinane  which  was  to  witness  the 
startling  onset  of  Birnam  Wood,  may  have  been  a tolerable 
abode  for  the  well  and  the  strong,  but  was  a dreary  place  for 
a sick  woman,  were  she  Queen  or  beggar. 

For  the  gentle  woman,  who  watches  the  sick  Queen,  this 
is  the  last — as  it  turns  out — of  many  nights  of  vigil  by  her 
bedside  ; for  the  doctor,  who  watches  with  her,  it  is  the  second. 
Being  the  second  and  there  being  as  yet  no  manifestation  of 
the  disorders  which  he  has  been  called  in  to  observe  and  pre- 
scribe for,  he  begins  to  doubt  their  existence.  This  old  time 
doctor  has  always  commanded  my  esteem,  especially  by  the 
honest  utterance,  to  which  I shall  presently  call  your  attention, 
but  partly,  also,  by  the  plain,  non-technical  language,  so  grate- 
ful to  the  layman,  in  which  he  discusses  the  Queen's  symp- 
toms. While  he  is  in  the  midst  of  this  simple  talk,  all  doubts 
that  he  has  previously  entertained  of  the  existence  of  her 
disorder,  are  set  at  rest;  for  there,  in  her  night  dress,  holding 
a taper,  “fast  asleep,”  her  “eyes  open,”  “but  their  sense  shut," 
she  stands  before  them,  seeming  to  wash  the  small  white  hand, 
which  “all  the  perfumes  of  Arbaia  cannot  sweeten,"  and  utter- 
ing broken — and  heart-broken — sentences,  full  of  dark  allu- 
sions to  the  night  of  horror,  in  which  her  ruin  commenced. 
Then  it  is  that  this  good  honest  doctor  exclaims:  “This  dis- 
ease is  beyond  my  practice.”  I take  this  sentence  as  the 
suggestion  of  a few  thoughts,  for  which  1 claim  no  higher 
value  than  for  a mere  placebo. 

It  was  not  strange  that  the  doctor  pronounced  this  disease 
beyond  his  practice.  At  least  it  was  not  strange  that  he 
thought  it  so,  however  faithless  he  may  have  been  to  the  tra- 
ditions of  his  profession,  in  making  this  open  confession  of 


3 


failure.  Not  strange,  for,  in  the  first  place,  at  any  stage  of 
medical  science,  this  would  have  been  a hopeless  case.  It 
would  have  been  not  less  so  in  the  nineteenth  century,  and  at 
the  Hotel  Dieu,  in  Paris,  than  it  was  in  the  eleventh  at  dreary 
and  battle  leaguered  Dunsinane.  For  the  Queen  had  poisoned 
the  springs  of  life.  She  had  planted  in  her  breast  “a  rooted 
sorrow.”  She  had  aroused  the  furies  and  now  they  took  their 
place  upon  the  midnight  pillow. 

“More  needed  she  the  divine  than  the  physician." 

Remorse,  for  which  there  is  no  specific,  had  done  its 
work  on  the  delicate  tissues  of  the  brain,  and  the  physician 
of  any  age,  from  Esculapius  to  Bro  vm-Sequard,  could  only 
recognize  in  her  case  a ruin. 

But  even  if  the  case,  instead  of  being  one  of  this  universal 
and  panchronous  hopelessness,  had  indeed  been  one  with 
which  modern  medical  science  deals  with  vase  and  success, 
in  all  probability  our  honest  Macbethian  doctor  would  still 
have  found  it  beyond  his  practice.  If  this  good  doctor  had 
been  in  Spain,  he  would  not,  perhaps,  have  so  soon  pronounced 
disease  in  general  beyond  his  skill.  The  Moors,  who  conquered 
that  country,  were  at  that  period  of  history  the  most  enlight- 
ened and  learned  people  in  Europe.  In  medicine  no  less  than 
in  everything  else  in  the  nature  of  science,  these  Orientals 
were  far  in  advance  of  the  people  of  the  West.  Had  our  good 
old  doctor  been  a turbaned  Moor,  he  would  not  have  been 
brought  so  early  in  an  ordinary  case  to  the  confession  of  the 
text.  But  being  only  a Scot  of  the  period,  his  learning  and 
science  soon  came  to  an  end.  For  Britain  was  like  the  rest  of 
Europe,  Spain  excepted,  rude  and  ignorant,  and  medicine 
which,  in  all  times  and  countries,  has  borne  some  direct  ratio 
to  general  learning,  was  in  a very  low  state.  Besides,  while 
there  is  no  evidence  that  our  excellent  Macbethian  doctor  w-as 
in  religion  any  thing  except  a layman,  as  a fact,  most  of  the 
practitioners  of  medicine  were  priests  and  monks,  and  prayers 
and  saints  were  more  in  demand  at  the  bedside  of  the  sick 
than  prescriptions  and  sinful  doctors.  What  bleeding  and  a 
very  limited  materia  medica  could  not  remedy  some  relic  of  a 
saint  might  cure ; but  if  the  relic  was  of  like  inefficacy,  the 
monkish  practitioner  of  this  sj^stem  of  medicine  must  then 
prepare  to  do  what  confession  and  shrift  could  do  for  the  part- 
ing soul.  Soon,  ah ! very  soon,  in  those  good  old  days,  did  the 
fine  old  doctor  reach  the  end  of  his  art.  With  anatomy  still 
oppressed  by  the  idea  that  it  was  sacrilegious  to  dissect  a 
human  body  ; with  the  circulation  of  the  blood  not  discovered  ; 

4 


with  the  theory  of  respiration  not  understood  ; with  a very 
limited  known  materia  medica ; with  chemistry  unstudied, 
except  as  the  means  of  discovering  the  philosopher's  stone — 
in  a word,  with  dense  ignorance  on  every  subject  relating  to 
medicine,  there  was  little  for  the  doctor  to  do  but  to  bleed, 
to  bleed  after  the  fashion  of  the  time  ; to  look  wise  after  the 
manner  of  his  brethren  of  all  times,  and  very  early  in  his  case, 
unless  the  vis  medicatrix  triumphed  over  disease  and  remedy 
alike,  to  make  the  confession,  at  least  to  his  own  heart,  that 
the  disease  was  beyond  his  practice. 

Returning  to  this  utterance  of  our  good  doctor,  I desire 
to  say  of  it  in  all  sincerity,  and  without  any  admixture  what- 
ever of  sarcasm,  that  he  ought  not  to  have  made  this  confes- 
sion under  ordinary  circumstances.  It  did  no  harm  on  this 
particular  occasion,  for  the  patient,  whom  it  might  have  in- 
jured, was  beyond  its  reach,  both  by  reason  of  the  general 
hopelessness  of  her  case  and  by  her  particular  state  at  the  time 
of  insensibility  to  actual  surroundings.  To  make  such  a con- 
fession to  a conscious  patient  would  be  unpardonable.  Its 
logical  sequence  would  be  the  abandonment  of  the  field,  where 
the  rival  forces  of  disease  and  health  are  contending.  To  do 
so  is  to  dismiss  the  strongest  ally  of  physician  and  patient — 
hope — and  to  reinforce  the  enemy  with  the  cohorts  of  despair. 
And  thus,  when  the  physician  seats  himself  by  the  couch  of 
his  patient,  his  first  duty  is  to  question  pulse  and  tongue,  and 
all  other  witnesses  of  his  patient’s  condition,  what  that  con- 
dition is  ; and  also  a part  of  that  duty  is,  though  he  may  doubt, 
though  he  may  question  in  vain,  to  assume  a tone  of  certainty. 
And  when  he  tells  his  patient  with  confidence  that  there  is  a 
spot,  which  he  locates  with  nicety  one  inch  from  the  lower 
part  of  the  left  lung,  and  a half  an  inch  from  some  other  point, 
the  size  of  a silver  dime,  inflamed  to  a certain  shade  of  redness, 
which  he  also  specifies,  and  that  it  is  the  inflammation  of  this 
spot  which  has  given  his  patient  fever  and  made  him  reflect 
upon  his  sins,  and  think  of  putting  his  house  in  order;  when  he 
does  this  so  unfalteringly  and  wfith  such  an  air  of  quiet  con- 
fidence that  the  patient  for  the  time  attributes  to  him  the  eye 
of  a lynx,  and  feels  satisfied,  that  though  he  is  himself  des- 
perately ill,  here  at  least  is  a man  who  knows  to  the  nicety  of 
a hair  what  is  the  matter  with  him  ; this  excellent  physician  is 
not  playing  the  charlatan.  He  is  simply  holding  a line  of  bat- 
tle, presenting  a brave  and  confident  front  until  the  disposi- 
tions of  the  enemy  can  be  accurately  ascertained.  He  may  not 
prescribe  and  treat  on  the  line  of  his  confident  assurances,  but 
he  will  put  out  his  skirmish  line  of  placebos  and  develop  the 

5 


enemy.  In  the  meantime  he  does  right  to  pretend  to  know  all 
about  the  disease  and  what  is  to  be  done.  What  good  general 
ever  on  the  eve  of  battle  expressed  to  his  soldiers  doubt  or 
apprehension  of  the  result?  He  may  feel  his  own  weakness 
and  know  his  enemy’s  strength.  He  may  at  the  moment  be 
prudently  preparing  for  defeat  and  planing  retreat,  but  his 
ringing  battle  orders  speak  only  of  advance  and  victory. 

I may  appear  to  treat  the  occasion  too  lightly.  But,  in- 
deed, such  is  not  my  intention.  I recognize  thoroughly  that 
levity  would  be  singularly  out  of  place  in  addressing  those, 
whose  experience  with  the  suffering  side  of  human  life  is 
about  to  begin.  I do  not  forget  how  much  of  the  time  of  the 
good  physicion  is  spent  in  the  solemn  border  land  between 
life  and  death — the  land  of  the  valley  and  the  river.  I remem- 
ber how  often  he  descends  into  the  misty,  shadowy  region 
neither  all  of  life  nor  all  of  death — but  partly  of  both — that 
region  where  the  every  day  sounds  of  this  life  seem  far  off 
and  low,  and  where  the  listening  ear  seems  to  hear,  faintly  at 
least,  the  waves  beating  on  the  other  shore.  I recollect  to 
him  suffering  and  anguish  in  every  form  are  frequent  com- 
panions. That  while  mingling  like  other  men  with  his  fellow- 
men,  his  pathway  is  thronged  with  mournful  shades.  I know 
that  the  cry  of  distress  is  a sound  in  his  ears  as  ceaseless  as 
that  which  breathes  faint  and  low,  but  forever,  in  the  concave 
shells  of  ocean.  I cannot  forget  that  the  day  which  dedicates 
you  to  such  a life,  hallowed  by  the  atmosphere  of  suffering  in 
which  it  is  to  be  spent,  ennobled  by  the  labors  and  anxieties 
which  it  is  to  endure,  is  no  time  for  jest  or  levity,  even  if  the 
subject  might  provoke  it.  And  standing  face  to  face  with 
the  life,  which  opens  to  the  faithful,  earnest  physician,  I 
would  lose  sight  of  all  the  provocations  to  satire,  which  might 
be  presented  by  the  blunders  and  absurdities  of  the  profession 
in  past  ages,  or  the  solemn  pretention  to  superhuman  wisdom 
sometime  observed  in  the  present;  and  I would  readily  adopt 
the  serious  tone  appropriate  to  this  occasion. 

In  that  tone,  and  returning  to  what  I call  my  text,  the 
next  reflection  suggested  by  it  is ; How  much  less  often  now 
is  the  physician  driven  to  this  despairing  utterance  even  to 
his  own  heart.  Since  those  old  days,  when  our  good  docioi 
confessed  the  end  of  his  skill,  stupendous  have  been  the  ad- 
vances in  all  departments  of  scientific  learning.  Xo  branch 
of  learning  has  outstripped  medicine.  The  human  intellect, 
whose  triumphs  have  reproduced  the  age.  of  miracles,  has 
shone  nowhere  more  brightly  than  in  the  science  and  piactice 
of  medicine.  It  woukrbe  presumptuous  in  me,  a layman, 

6 


addressing  professional  men  in  reference  to  their  own  pro- 
fession, to  undertake  to  speake  minutely  of  the  causes  and 
results  of  this  wondrous  change.  1 can  speak  but  in  general 
terms.  The  ignorant  empiric  of  old  has  given  place  to  the 
man  of  science  ; materia  rnedica  grown  from  a few  simples  to 
proportions  co-extensive  with  the  vegetable  and  mineral  world. 
The  knowledge  of  anatomy  changed  from  the  assumed  analogy 
between  frames  of  the  lower  animals  and  man's  to  accurate 
knowledge  of  the  human  organization  itself.  Pain  and  physi- 
cal anguish,  the.  fell  destroyers  of  thousands,  whom  the  disease 
itself  would  have  spared,  conquered  by  blessed  anesthetics. 
Multitudes  of  disorders  cured  by  surgical  operations,  then  not 
ventured,  or  by  remedies  not  then  known.  And  as  the  result 
of  these  changes,  and  of  others  more  numerous  and  more  vast, 
which  you  know  better  than  I do,  the  material  lengthening  of 
the  average  human  life.  If  I might  venture  an  opinion  touch- 
ing the  accomplished,  and  a speculation  in  reference  to  the 
prospective,  I would  say  that  the  triumphs  already  achieved 
and  the  hope  of  conquests  yet  to  be  made  depend  most  of 
all  upon  those  things  that  relate  to  diagnosis.  Am  I not 
right  in  thinking  that  all  the  means,  scientific  and  mechanical, 
which  enable  the  physician  to  see,  actually  to  see,  the  seat  of 
the  disease,  to  hear,  aye  actually  to  hear,  the  language  of  the 
afflicted  organ,  are  immense  gains  in  the  practice  of  the  healing 
art?  It  is  one  thing  to  stand  outside  the  living  human  frame  and 
conjecture  what  may  be  its  hidden  disease,  and  quite  another 
to  see,  by  the  aid  of  medical  inventions,  the  disorder  no  longer 
hidden.  Put  yourselves  back  along  with  your  brethren  of 
former  times,  who  had  not  the  speculum,  the  stethoscope, 
ophthalmoscope,  or  the  auroscope,  to  whom  the  interior  of  the 
living  human  organism,  for  lack  of  these,  was  wrapped  in  im- 
penetrable darkness;  for  whom  the  heart  and  the  lungs  were 
dumb,  or  spoke  only  in  muffled  tones;  and  consider  your  im- 
mense advantage.  It  is  the  advantage  of  certainty  over  con- 
jecture, of  knowledge  over  guessing — the  advantage  of  the 
sure  evidence  of  eye  and  ear  over  the  uncertain  results  of 
fallible  reasoning — it  is  such  inventions  as  these,  that  showing 
the  physician  where  and  what  is  the  trouble,  enable  him  to 
deal  intelligently  with  it.  But  while  these  are  vast  strides, 
after  all  how  far  short  of  the  exigencies  of  the  case  do  they 
stop.  The  greater  part  of  the  human  frame  is  still  impene- 
trable to  the  eye  of  the  physician  so  long  as  it  lives.  That 
life,  which  it  is  the  object  of  the  physician  to  save,  stands  an 
impregnable  fortress  in  his  path,  when  he  seeks  to  penetrate 
the  lurking  places  of  the  enemies  of  life.  All  the  aid  of  the 


stethoscope,  what  is  it?  The  physician  hears  the  rush  of  the 
stream  of  life;  he  sees  it  not.  The  traveler  hears  in  the  dis- 
tance the  flow  of  waters,  and  knows  that  whence  it  comes 
some  majestic  river  is  coursing  towards  the  sea,  but  not  until 
he  approaches  and  stands  upon  its  banks,  will  he  see  its 
breadth  and  understands  it  depth,  and  know  what  pleasant 
islands  or  what  rugged  rocks  obstruct  its  course;  whether  its 
waters  flow  clear  and  limpid  or  roll  along  muddy  and  turbid. 
With  the  aid  of  this  same  invaluable  stethoscope,  the  physi- 
cian can  hear  the  passage  of  air  through  the  lungs,  but  he 
cannot  see  the  trace  it  leaves.  He  is  as  one  walking  abroad, 
who  hears  in  the  distance  the  sweep  of  the  wind  and  the 
noise  of  the  waves,  but  not  until  he  approaches  the  coast  and 
casts  his  eye  abroad  over  the  sea,  will  he  know  whether  it  be 
a gentle  breeze  whispering  to  the  wave  and  the  wave  kissing 
the  pebbly  beach,  or  the  rushing  of  the  gale  and  the  roar  of  the 
breakers."  And  so  medical  science  should  not  relax  its  re- 
searches until  that  which  is  now  only  heard  with  the  ear  shall 
be  seen  also  with  the  eye.  And  is  there  anything  wild  in  this 
suggestion?  Already  through  the  stethoscope  the  heart  has 
given  up  its  secrets  and  the  lungs  have  whispered  their  tale 
of  life  or  death  to  the  listening  ear.  Already  the  brain  has 
revealed  through  the  ophthalmoscope  some  of  its  mysteries 
to  the  searching  eye.  And  the  auroscope  has  found  a clue 
even  to  the  intricacies  of  the  ear,  though  the}-  be  complex  as 
the  labyrinth  of  Crete.  Have  the  stethoscope,  the  ophthalmo- 
scope and  the  auroscope,  exhausted  the  inventive  mind?  Do 
these  triumphs  of  science  mark  also  the  limits  of  science?  And 
is  it  wild  to  anticipate  that  some  new  application  of  the  laws 
of  light,  some  new  wonder  of  electricity,  some  agent,  old  or 
new,  may  yet  reveal  to  the  eye  of  the  physician  the  now 
hidden  wonders  of  the  living  frame,  so  that  they  will  be  seen 
as  a man  sees  the  face  of  Ins  friend?  Every  daily  newspaper 
reveals  a greater  marvel.  One  man  sits  in  lus  office  at  A\  asn- 
ington — there  comes  flashing  to  him  this  message  from  a peak 
in  the  Rocky  Mountains:  The  snow  is  falling  thick  and  fast 
along  the  mountain  sides.  From  the  great  lakes  comes  ano fli- 
er: A mighty  wind  is  rushing  from  the  Northwest  to  the 

Southeast,  whose  breath  is  icy.  The  Atlantic  sends  up  from 
its  coasts  a notice  of  fog  and  mist.  The  Gulf  makes  signal  ot 
rain.  Our  own  Georgia,  perhaps,  sends  a joyous  gieeting  ci 
clear  skies  and  soft,  light  winds;  and  Florida  takes  up  the 
refrain,  “fair  and  still,"  “still  and  fair.  And  to  this  man. 
receiving  these  messages,  the  future,  hitherto  wrapped  in 
more  impenetrable  darkness  than  the  hidden  paits  of  the  m 

8 


ing  human  frame,  is  revealed ; and  the  march  of  the  elements, 
hitherto  less  understood  than  the  progress  of  disease,  is  spread 
out  before  him,  and  back  goes  the  message  to  this  place : 
Display  storm  signals  and  let  the  ships  ride  at  anchor.  To 
this  other:  Let  the  barque  sail  with  the  assurance  of  sunny 
seas  and  favoring  winds.  In  advance  of  the  icy  blast  speeds 
the  warning  to  the  farmer:  Seek  shelter  for  your  flocks  and 

herds;  while,  in  another  direction,  wings  the  message:  Drive 

your  teams  afield  under  a clear  sky  and  amid  the  whispering 
of  Spring.  Seeing  the  wonderful  triumphs  of  the  human  in- 
tellect, is  it  extravagant  to  anticipate  a not  distant  day  when 
all  parts  of  the  living  human  frame  will  lie  bare  to  the  eye  of 
the  physician.  Then,  knowing  for  a certainty  what  the  disease 
is,  how  seldom  he  will  have  occasion  to  say : “This  disease 

is  beyond  my  practice.” 

But  the  discoveries  of  science,  the  triumphs  of  mechanism, 
may  be  what  they  may  be  in  aid  of  the  healing  art;  but  one 
disease  will  continue  to  be  beyond  the  practice  of  the  most 
skillful  physician.  This  so-called  disease  is  death.  \Ye  lis- 
tened, yesterday,  with  delight  to  a discourse  delivered  by  the 
honored  Dean  of  the  Faculty,  which  proceeded  on  the  highest 
planes  of  thought,  was  enriched  by  the  stores  of  profound 
learning,  and  swept  along  in  the.  strains  of  the  purest  diction. 
Its  theme  was  the  Persistence  of  Life.  AYe  have  no  occasion 
to  oppose  these  grand  speculations.  This  rapt  vision  of  the 
philosopher  may  be  realized,  but  death  of  that  human  frame, 
which  is  the  field  of  the  physician’s  labor,  will  continue.  The 
forces  of  life  may  persist  in  another  form;  but  this  vision  of 
the  philosopher  does  not  contemplate  a time  when  the  forces 
of  life  shall  be  so  understood  that  their  exhaustion  in  the 
human  frame  may  be  prevented  ; that  the  seat  of  life  will  be  so 
well  ascertained  that  it  can  be  effectually  guarded.  It  does 
contemplate  that  this  human  frame  shall  still,  like  the  house 
of  the  chambered  nautilus,  be  left  “an  out-grown  shell  by  life’s 
unresting  sea.”  Nor  need  we  contend  with  the  theologian, 
who  teaches  that  death  came  by  sin,  and  cry  out  in  unbidden 
doubt:  The  birds  of  the  air,  the  songsters  of  hedge  and  grove, 
when  sinned  they?  And  yet,  do  their  pinions  never  fail  and 
do  their  voices  not  cease  their  sweet  notes  forever?  By  what 
deadly  impurity  did  the  violet  and  the  lilly,  the  jasmine  and 
the  rose,  forfeit  their  pristine  immortality?  When  did  the 
falling  leaf  become  the  solemn  declaration  that  all  nature  had 
sinned?  It  is  enough.  Philosophy  and  theology  alike  recog- 
nize the  continuance  of  death.  But  why  call  death  disease? 
Why  regard  it  otherwise  than  birth  itself?  They  are  both 

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stations  in  the  existence  of  that  mystery,  which  we  name  man. 
Death  marks  the  separation  between  the  living  and  “those 
other  living  ’whom  we  call  the  dead.”  Premature  death  is 
disease.  The  buds,  which  put  forth  today  to  greet  the  first 
morning  of  Spring,  may  in  their  immaturity  meet  a chilling 
frost,  wither,  decay  and  die.  This  is  disease.  But  the  rose 
which  opens  to  the  April  sky  and  blooms  in  all  its  beauty,  and 
shed's  all  its  fragrance  on  the  vernal  air,  and  in  due  time 
scatters  its  last  leaves  upon  the  ground,  is  not  the  victim  of 
disease.  It  has  filled  to  the  full  the  measure  of  its  being.  And 
so  with  the  wonderful  human  frame.  There  is  hope  that,  with 
the  progress  of  knowledge,  no  disease,  which  shortens  its  due 
existence,  will  be  beyond  the  practice  of  the  physician.  But 
that  which  marks  its  termination — as  the  falling  rose  leaf 
whispers  that  the  perfect  mission  of  the  rose  is  accomplished 
— will  be  alike  for  philosopher,  theologian  and  physician,  ever 
"beyond  his  practice.” 


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